Sexual healthcare at schools and reproductive healthcare at clinics
Vision
Optimum health and welfare for individuals and communities in North West province
Mission
To co-ordinate and deliver accessible, equitable, affordable and efficient and effective developmental health and welfare services through community participation in the North West Province
NWP Health and Social Welfare Department
Request for bridging funds (September 1998 - May 1999)
1. Executive Summary
HIV/AIDS is quickly spread when other sexually transmitted diseases are prevalent. Under 25’s, especially women, are most vulnerable. Every second teenage girl in SA spoils her life chances by pregnancy. Rural women and youth can be employed cost effectively to overcome AIDS and teen pregnancy.
sexuality education is best taught full-time at school by a young person from the community, supported by regular school visits by community healthcare workers. An existing team currently needs bridging finance to prove a pilot project.
St Peter’s Mandlenkosi Community Family Health Company
Two professional nurses and 10 community health workers run two community clinics of long standing (St Peter’s Clinic and St Joseph’s Clinic). They are currently forming a section 21 company (not-for-gain). The nurses will be the managers and draw up the business plan, make operational decisions and manage expenditure. The board, drawn from the community will approve and review the business plan and keep communication flowing. From May 1999, when EU funding becomes available, a third nursing sister will be employed.
SAPLER Pioneers
SAPLER Population Trust is dedicated to universal, friendly, accessible family planning and responsible sexuality among teenagers. A Pioneer, a young person from the community, educates pupils full-time about postponing sex, faithfulness and safe sex practices. Classroom discussion of choices, relationships and responsibility builds intelligent self-confidence among pupils.
School sexuality education needs school sexual healthcare
School sexuality education is less effective if sexual health services are deficient. St Peter’s can provide sexual healthcare at schools fortnightly with a small team of community health workers lead by a professional nurse, in co-operation with the district health system. Family planning, care for pregnant women, mother-and-child care and out-of-school youth sexual healthcare can continue at St Peter’s own two clinics.
Funding appeal for St Peter’s
The Pioneers are contracted by Northwest Province Aids Awareness Fund for NGOs and SA Breweries. However, currently Odi Health District funds St Peter’s nurses and medicines only. SAPLER is providing a stipend of R200 p.m. to the community health workers in the interim and will provide them with sexual healthcare training to support the Pioneers at schools.
School sexual healthcare is planned to expand rapidly. There are about 45 middle and high schools in Odi and Klipgat. St Peter’s appeals for funding for R98 400 for October 1998 to May 1999 to assist the formation of 2 school sexual health teams that will accelerate operations once the EU funding is available.
From May they will fit into the Odi Health District health plan and share in funding from the EU under the auspices of CATHCA (R815 000 p.a.for three years. The seven participating organisations will share a total of $23m over 3 years).
By the end of 2000, about 30 000 teenagers could be safeguarded from AIDS and teen pregnancy for an operating cost of about R2.50 per pupil per month.. SAPLER is advocating this plan as a model for the Job Summit / Business Trust.
2. St Peter's and St Joseph's Clinics
Background information
St Peters Mandlenkosi clinic is a non-governmental organisation that has been in operation for about 20 years. The clinic was set by the archdiocese of Pretoria under the leadership of Father Smangaliso Mkatshwa. The clinic is situated in the southern densely populated Klippan area about 45 kilometres north west of Pretoria.
In 1992, with the assistance of the Anglican diocese of Pretoria, St Joseph's clinic was started as an extension of St Peter's clinic. St Joseph's clinic is about six kilometers north east of St Peter's clinic in the Molapo Maseko area.
Staff
Community health workers
In 1988 five community health workers (CHW's) were employed at St Peter's with the assistance of Medicines Du Monde (MDM - Doctors of the World). MDM doctors trained CHW’s with the financial assistance from professional nurses working at the clinic. Their training involved health education home visiting, basic knowledge on nursing procedures like taking of temperatures, blood pressure monitoring, urine testing, dispensing of medicines, dressings, weighing of adults and babies. Some are trained in the injection of babies and basic diagnostic skills.
In 1989, because of the prevalence of malnutrition in babies, a nutrition rehabilitation unit was started with the assistance of Goldfields Nutrition, MEDUNSA under the then directorship of Dr Martin Bach. 2 CHW's, as mothers of nourished babies, were identified and trained by Goldfields Nutrition. The two CHW's were employed St Peter's clinic with the financial assistance of Goldfields.
Professional nurses
The clinic started with one professional nurse who worked on weekends in the vestry of the Catholic Church on the plot. The number grew to three professional nurses and one staff nurse as the number of patients increased. The two clinics presently have 2 professional nurses, which will expand to 3 from May 1999.
Directors
The clinic director was Mr Aubrey Mokeona who was replaced by Mr Ata Mkhwanazi in 1986. Mr Mkhwanazi left the clinic in 1997.
Winterveld Nutrition Centre
In 1992 – 93 a nutrition rehabilitation centre was built at 1345 Nyamakazi stand with the assistance of Mrs. D Mitterand. The centre is presently not used but will soon be used by mothers of underweight babies, with the assistance of the North West Province Government.
Community based rehabilitation
In 1990 a community-based facilitator was trained at Alexandra clinic. St Peters employed her until 1996. She is now employed by Odi hospital with the assistance of the occupational therapy unit at MEDUNSA.
Two more community-based facilitators have been trained. The three facilitators work mainly in the community. An organisation of disabled people - Thusanang - has been started and operates in the old Roman Catholic Church Hall. Mr James Ndaba, the landlord, donated the Hall to the organization.
Funding
The clinic has in the past been funded by:
Trocaire
Kaiser Family Foundation,
Oxfam
Medicines Du Monde
European Union
North West Province Government
The European Union funded the clinic until 1996. The clinic then received funding from the North West Province Government. A joint funding proposal of all health NGOs Winterveld has been submitted to the European Union under the umbrella of CATHCA (Catholic Healthcare). On approval the European Union will fund the NGOs for a period of three years.
Clinic activities
The clinics' main emphasis is on preventative and promotive health. The clinics were attending to minor ailments until May 1997,after which the reduced funding only covered salaries. Money received from the North West Province Government is not enough to purchase medicines and pay staff salaries. The clinics presently attend to antenatal and postnatal care, immunisation of babies and family planning (St Joseph's clinic only).
The proposed retraining of community health workers to also provide school sexual health in support of sexuality education is intended to be very cost effective. Schools need only modest additional expenditure to overcome teen HIV/AIDS and pregnancy.
3. SAPLER Population Trust
Trustees
The Sapler Population Trust was formed in 1990 by Johannes Jordaan, author of "Population Growth – our time bomb", Beryl Unterhalter, Wits demographer, and the existing trustees, Zanele Mfono (demographer at Fort Hare), Dr Nthato Motlana, Prof. Harry Seftel and Ann Weinberg (Chairperson). David Hirsch (currently executive director) is also a trustee. SAPLER stands for Splendidly Alive People with Limited Environmental Resources.
Honorary trustees include Archbishop Desmond Tutu, Mr Frank Talbot, director of the Smithsonian Museum of Natural History, the internationally renowned couple Paul and Ann Ehrlich, authors of the book "The Population Explosion", Dr John Hanks of WWF-SA and John Ledger of Endangered Wildlife.
Activities
SAPLER published a 150-page survey of family planning in South Africa in 1994. In 1995 it began an unsuccessful community based family planning programme in Winterveld which ultimately grew into the Pioneers’ programme.
Sapler advocates giving family planning and responsible teenage sexuality priority. The cost of preventing an HIV infection or an unwanted birth is small in comparison to the cost of coping with it - both in human and financial terms.
In 1997, Sapler encouraged oral submissions to the hearings on the white paper on Population Policy. SAPLER is promoting the concept of this proposal as a Job Summit initiative for South Africa. Recently, it submitted a comment on the Draft Policy on HIV/AIDS and STDs in Schools and Tertairy educational institutions.
SAPLER Pioneers’ sexuality education in Odi and Klipgat / Hebron schools
Young people from Odi given basic training and managed by a guidance teacher have proved they can give effective sexuality education in local schools. By the end of 1998, the programme had provided 2 terms of sexuality education (a lesson to each class each week) to 16 schools. 12 Pioneers are working full time at 12 new schools in1999.
Pioneers are more effective sex educators than guidance teachers because they:
Mr Edward Mabunda, assisted by Ms Lettie Dube, manages the Pioneers and negotiates with stakeholders in Odi Health District system and Odi and Klipgat/Hebron school district systems. He maintains contact with SAPLER executive director David Hirsch in Johannesburg.
4. The Plan
Problem Statement / Description of Needs
Teenage Sexual Health
A teenager, especially a girl, often has to find and spend time and money and may have to dissemble to get to a clinic regularly for sexual healthcare. The clinic may be out of the way, unsympathetic, overloaded or too public. Failures to attend the clinic increase risk of pregnancy and sexually transmitted diseases (STDs) which strongly increase the risk of HIV transmission. Teenagers need regular, friendly, accessible sexual healthcare to backup sexuality education.
Reproductive Healthcare for Families
Professional nurses at overburdened clinics are usually short of time. Family planning, care for pregnant women and mother-and-child care requires time-consuming consultation, education, monitoring and routine treatment often not available from clinics. Women need care from community health workers for most of their reproductive health needs. The professional nurse should be on hand to supervise, diagnose and treat disease and perform specialised tasks.
Aims and Objectives
Teenage Sexual Health
Aim: Teenagers to be sexually responsible with no pregnancies, STDs nor HIV.
Objective: School sexual health teams visiting each school fortnightly to support of school sex educators teaching every class at least once a week, for half the school year. Arrangements to cope with school holidays will emerge from consultations with schools and clinics as the programme is implemented.
Out-of-school youth to have access to clinics connected with the school programme.
Reproductive Healthcare for Families
Aim: Families, especially women, to have friendly, accessible care of their reproductive health needs.
Objective: Community health workers to provide most of the reproductive health needs under the supervision of a professional nurse at St Peter’s and St Joseph’s clinics (and other health points, in consultation with the district health system).
Detailed Services by St Peter’s Health Teams
School sexual health:
Family planning:
Care for pregnant women
Mother-and-child care
Out-of-school youth
Target Groups and Target Areas
Pupils at middle and high schools in Odi Health District (Odi and Klipgat/Hebron school districts)
Communities around St Peter’s and St Joseph’s clinics
Communities around health points in under-served areas in Odi (in consultation with Odi District Health )
Motivation
Odi Health district commissioned a survey in Winterveld earlier this year. Odi district generally has a high rate of unplanned pregnancies, teenage pregnancies, HIV/AIDS and STDs. Many households headed by women.
Unemployment and poverty is widespread. Although knowledge of contraception is high, clinics show the fertility rate is high and likely to be reduced by more friendly, accessible, community based family planning.
The rate of pregnancy among pupils is high and of great concern to the teaching staff at schools. The Pioneer programme is already fairly successful and is likely to become fully effective if backed by a school sexual healthcare team.
A modest charge will be made for a consultation, waived for those in need and unable or unwilling to pay. A modest charge is likely to raise the standard of service by providing an incentive to the workers, reducing management effort, encouraging clients to expect good service and reducing unnecessary service. Fees will accrue directly to the team and Pioneer.
Schematic Plan
| Activity / Intervention | Anticipated Outcome | Time Frame | Indicators |
| School recruited to join Pioneer programme | Principal and Pioneers agree to begin sexuality education by full-time Pioneer | 1 month | Agreement document |
| Pioneer begins sexuality education at a school | Pupils become aware of responsible sexual behaviour, contraception and safe sex practices | 2 terms at a school | Lessons reported weekly, plans monthly |
| St Peter’s sexuality education teams retrained |
Certified training for community health worker team to provide school sex health visits under supervision of a professional nurse | 1 week 26-30 Oct 1998 |
Syllabus and certificates |
| School asked to join Peter’s school sex health programme | Principal, Odi Health District, local clinics and St Peter’s health team agree on arrangements and time-table for fortnightly visits by school sex health team during term and arrangements for school holidays | 1 month | Agreement document |
| School sexual health team commences fortnightly visits | Pupils attend school sex clinic for consultations, contraception and referrals | Indefinitely | Summary reports fortnightly |
| St Peter’s re-launched community family health company | People planning families, pregnant women, mothers and children and out-of-school youth visit St Peter’s and St Joseph’s clinics | Indefinitely | Patient records and medicines usage summaries |
| St Peter’s provides family health in under-served areas, in consultation with Odi District Health | People planning families, pregnant women, mothers and children and out-of-school youth visit temporary health points | Indefinitely | Patient records and medicines usage summaries |
| 3 monthly meetings of St Peter’s to report to community members | Communication of results, successes, failures and opportunities to stakeholders | 3 monthly | Public meeting, business plan, reports and minutes |
Narrative Plan
The Pioneers are realistically hopeful that their contract with NWP Aids Awareness Fund for NGOs will be renewed and increased in 1999. By mid year 1999, Pioneers 28 secondary schools in Odi and Klipgat/Hebron educational districts will have had at least two terms of weekly sexuality education lessons for every class.
The schools programme has been successful, with teen pregnancy (and by implication STDs and HIV) reduced but not eliminated. Experience has shown that teen pregnancy can quickly increase after a Pioneer moves on to a new school if adequate arrangements are not made.
St Peter’s is intending to be registered as a section 21 company not-for-gain. Two (from May 1999 three) professional nurses will manage it under the overall management of a doctor. The board will direct it and management will report to the CATHCA steering committee, and its members, donors and the wider community three-monthly.
St Peter’s will create two school sexual health teams with specific retraining to support this role from its existing complement of two professional nurses and ten community health workers. They will provide sexual healthcare to a school by visiting fortnightly, with arrangements made in consultation with the education and health districts to continue during holidays. They intend to support all or most schools by the end of 1999.
The Pioneers and St Peter’s will share administrative resources at St Peter’s clinic - a secretary, clerk and computer. They will both receive support form SAPLER head-office for publicity, fund raising, research and liaison with other organisations. The seven participating organisations, under the aegis of CATHCA, will share training, information and management resources.
Contingency Plan / Sustainability Plan
The school health teams cannot function without a car or bakkie (which can be parked overnight at the police station). The plan will be funded from May by the EU in all respects except for purchasing and running two bakkies (R60 000 + R14400), the stipends (R18 400) which have and are keeping the team in being, and the retraining already provided (R6000).
Targets
| March 99 | April 99 | May98 | Jun 98 | Aug 99 | Sept 99 |
Oct 99 | Oct 2000 | |
| Schools visited fortnightly | 1 | 1 | 3 | 3 | 5 | 8 | 12 | 40 |
| Consultations | 100 | 100 | 300 | 300 | 500 | 800 | 1200 | 4000 |
| School population served | 700 | 1400 | 2100 | 2100 | 3500 | 5600 | 8400 | 28000 |
| Consultations | March 99 | April 99 | May98 | Jun 98 | Aug 99 | Sept99 | Oct 99 | Oct 2000 |
| Family planning | 100 | 200 | 300 | 300 | 300 | 300 | 300 | 300 |
| Pregnant mother | 100 | 125 | 150 | 150 | 150 | 150 | 150 | 150 |
| Mother-and-child | 60 | 80 | 100 | 120 | 120 | 120 | 120 | 120 |
| Out-of-school youth | 10 | 20 | 20 | 20 | 20 | 20 | 20 | 20 |
| Minor ailment | 30 | 40 | 50 | 60 | 60 | 60 | 60 | 60 |
| Total | 300 | 465 | 620 | 650 | 650 | 650 | 650 | 650 |
5. Contact Persons and Addresses
CATHCA
Mr Alan Schwarer (trustee) 726-2463 or 082-3300-0797
Mr John Perks (trustee) 011-788-8775 or 083-440-2452
St Peter’s Mandlenkosi Family Health Company
St Peter's Mandlenkosi Clinic, 1615 Ndaba Stand, Winterveld
St Joseph's Clinic, 1378 Anglican Stand, Winterveld
Contact person: Sister Thuli Mzamane
012-04-1600 (work)
012-797-4909 (home)
082-259-5257 (cell)
SAPLER Pioneers
St Peter's Mandlenkosi Clinic, 1615 Ndaba Stand, Winterveld
Contact persons: Mr Edward Mabunda (manager)
012–704-1600 (work)
082-815-1878 (cell)
Ms Lettie Dube (deputy manager)
012-798-4492 (home)
SAPLER Population Trust
89 West-Side Ridge, Korea Rd, WESTDENE 2092
Contact person: Mr David Hirsch (executive director)
011-477-6447 (home and work)
082-859-9870 (cell)
NWP Education Department, Odi Region
Private Bag X579, MABOPANE, 0190
Contact person: Ms Tutu (Regional Auxiliaries Manager)
012-702-2214
NWP Health and Social Welfare Department, Odi Region
Odi Hospital, Private Bag X509, MABOPANE, 0190
Contact person: Ms Dabea Gaboutloeloe (Debs)
(Odi Regional Manager STDs and HIV/AIDS)
012-704-2274/9
082-959-0966 (cell)